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AU '18 - Peds III exam II > Cardiac > Flashcards

Cardiac Flashcards

1
Q

questions to ask ANY cardiac patient

A
  1. what TYPE of cardiac disease?
  2. who is managing cardiac disease?
  3. any hx of cardiac surgery?
  4. any special positioning precautions?
  5. any dental pain right now?
  6. current list of heart medications?
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2
Q

what is the #1 birth defect?

A

congenital heart defects (CHD)

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3
Q

what percent of births per year in the US have CHD?

A

1% - or ~40,000

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4
Q

T/F: the prevalence of some CHDs, especially mild types, is increasing, while the prevalence of other types has remained stable

A

true

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5
Q

what is the most common type of heart defect?

A

ventricular septal

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6
Q

what percent of babies with a CHD are critical?

A

~25%

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7
Q

T/F: infants with critical CHDs generally need surgery or other procedures in their first year of life

A

true

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8
Q

what percent of babies born with a non-critical CHD are expected to survive to one year of age?

A

~97%

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9
Q

what percent of babies born with a non-critical CHD are expected to survive to 18 years of age?

A

~95%

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10
Q

what are the most common types of CHDs?

A
  1. ASD
  2. VSD
  3. atrioventricular septal defect
  4. coarctation of the aorta
  5. hypoplastic left heart syndrome
  6. pulmonary atresia
  7. tetralogy of fallot
  8. total anomalous pulmonary venous return
  9. tricuspid atresia
  10. d-transposition of the great arteries
  11. truncus arteriosus
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11
Q

what is CHDs often associated with?

A
  1. Down syndrome
  2. inborn errors of metabolism (i.e. homocystinuria)
  3. CT disorders (i.e. osteogenesis imperfecta)
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12
Q

T/F: most CHD problems are minor or self limited

A

true

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13
Q

what percent of infants born with a CHD will have a critical condition (will need surgery or other procedures during their 1st yr of life?

A

~25%

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14
Q

between 1986-1996, mortality was reduced by what percent?

A

18% thus population of people with CHDs is growing

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15
Q

normal cardiac fxn

A
  1. oxygen poor blood –> 2. right atrium –> 3. tricuspid valve –> 4. right ventricle –> 5. pulmonary artery –> 6. lungs –> 7. left atrium –> 8. mitral valve –> 9. left ventricle –> 10. aorta
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16
Q

atrial septal defect (ASD)

A

abnormal opening between the right and left atria

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17
Q

what happens with ASD?

A

blood of right and left atrium mix

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18
Q

T/F: 2:1 male to female ratio for ASD

A

false, 1 male : 2 female

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19
Q

T/F: ASD is symptomatic

A

false, asymptomatic

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20
Q

what may happen if the ASD is large?

A
  1. pulmonary hypertension
  2. right side heart enlargement
  3. cardiac heart failure
  4. atrial arrhythmias
  5. stroke
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21
Q

what are the different types of ASD?

A
  1. secundum
  2. sinus venosus type
  3. ostium premium
  4. coronary sinus atrial septal defect
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22
Q

what percent of all ASD cases are secundum type?

A

80%

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23
Q

secundum ASD

A

failure of the atrial septum to close during development

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24
Q

sinus venosus ASD type

A

drainage of right pulmonary vein into right atrium instead of left

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25
Q

ostium premium ASD

A

clefting of mitral valve (family of atrio-ventricular canal defect)

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26
Q

which ASD type is commonly associated with Down syndrome?

A

ostium premium ASD

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27
Q

what percent of individuals with Down syndrome have AV septal defect?

A

~65%

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28
Q

where is the coronary sinus atrial septal defect?

A

within coronary sinus

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29
Q

T/F: coronary sinus atrial septal defect is the more common type of ASD

A

false, more RARE

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30
Q

ventricular septal defect (VSD)

A

abnormal opening between the ventricles

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31
Q

T/F: VSD usually occur by themselves, without other birth defects

A

true

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32
Q

what percent of all CHDs are VSD?

A

~30%, about 1 in 500 new births

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33
Q

T/F: VSD is slightly more common in males

A

false, females

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34
Q

the clinical significance of VSD is directly reflected to what?

A

the size of the defect

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35
Q

VSD is similar to what?

A

having one ventricle (“Fontan Circulation”)

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36
Q

what are the different types of VSD?

A
  1. membranous
  2. muscular
  3. atrioventricular canal type VSD
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37
Q

what is the most common type of VSD?

A

membranous

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38
Q

T/F: surgery is often needed with membranous VSD

A

true

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39
Q

what is common with singular muscular type of VSD?

A

spontaneous closure

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40
Q

how is multiple muscular VSD described?

A

“Swiss cheese”

41
Q

T/F: multiple muscular VSD requires very complex surgical management

A

true

42
Q

where is the atrioventricular canal type VSD?

A

near tricuspid

43
Q

what is needed to fix atrioventricular canal type VSD?

A

surgery needed

44
Q

patent ductus ateriosus

A

failure of ductus arteriosus to close after birth

45
Q

what does patent ductus ateriosus lead to?

A

leads to blood travelling from aorta to pulmonary artery

46
Q

the blood in patent ductus ateriosus is initially what and leads to what if not tx’d?

A

acyanotic (left to right) to cyanotic (right to left)

47
Q

T/F: patent ductus ateriosus has 2:1 female to male

A

true

48
Q

patent ductus ateriosus affects how many premature births?

A

8:1000

49
Q

patent ductus ateriosus affects how many term births?

A

2:1000

50
Q

what causes tetralogy of fallot?

A

an abnormal location of the muscle that separates the aortic valve and the pulmonary valve

51
Q

what is the male:female ratio for tetralogy of Fallot?

A

3 male:2 female

52
Q

what is the most common cyanotic defect after 1 year old?

A

tetralogy of Fallot

53
Q

what is often present at birth with tetralogy of Fallot?

A

patent ductus arteriosus

54
Q

tetralogy of Fallot

A
  1. VSD: less oxygenated blood to body
  2. pulmonary stenosis: less blood to lungs
  3. (R) ventricular hypertrophy: increased work
  4. transposition of the aorta: less oxygenated blood to body
55
Q

what complications do children with tetralogy of Fallot often have?

A
  1. pacemakers sometimes required
  2. post-surgical arrhythmias (bradycardia)
  3. residual post-surgical defect
  4. fatigue/cyanosis
56
Q

coarctation of the aorta

A

narrowing of aorta

57
Q

what does coarctation of the aorta cause?

A
  1. upper body HTN

2. lower body hypotension

58
Q

what is coarctation of the aorta often accompanied by?

A

aortic valve defects

59
Q

where is coarctation of the aorta?

A

where ductus arteriosus closes

60
Q

indications for pediatric heart transplantation

A
  1. life expectancy <1 year

2. significant limitations on daily life

61
Q

causes of end-stage heart disease in children

A
  1. viral or idiopathic cardiomyopathy

2. severe congenital heart defects

62
Q

how many pediatric heart transplants are performed per year?

A

~500

63
Q

T/F: it is difficult to obtain donors for pediatric heart transplants

A

true

64
Q

T/F: pediatric heart transplants are a palliative measure, not curative

A

true

65
Q

what improved the survival rate after pediatric heart transplant?

A
  1. advancements in PICU
  2. immunosuppression is more effective
  3. statins to reduce coronary disease
66
Q

what is the first choice of immunosuppressive drug for pediatric heart transplant?

A

Tacrolimus

67
Q

why is Tacrolimus the first choice immunosuppressive drug for pediatric heart transplant?

A

no gingival overgrowth

68
Q

which immunosuppressive drug for pediatric heart transplant is used less now?

A

steroids

69
Q

survival of pediatric heart transplant is approximately what percent at 3 years?

A

90%

70
Q

who needs SBE prophylaxis?

A
  1. prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts
  2. prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords
  3. hx of infective endocarditis
  4. cardiac transplant with valve regurgitation due to structurally abnormal valve
71
Q

which congenital heart diseases require SBE prophylaxis?

A
  1. unrepaired cyanotic congenital heart disease including palliative shunts and conduits
  2. any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device
72
Q

infective endocarditis is more common in what type of patients?

A

heart transplant recipients than in the general population

73
Q

when is the risk of infective endocarditis the highest?

A

the first 6 months after transplant

74
Q

why is the risk of infective endocarditis the highest in the first 6 months after transplant?

A

because of

  1. endothelial disruption
  2. high-intensity immunosuppressive therapy
  3. frequent central venous catheter access
  4. frequent endomyocardial biopsies
75
Q

pediatric patients that need SBE prophylaxis

A
  1. cyanotic CHD that has not been fully repaired, including children who have had surgical shunts and conduits
  2. CHD that’s been completely repaired with prosthetic material or a device for the first 6 months after the repair procedure
  3. repaired CHD with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device
76
Q

cyanotic CHD

A

birth defects with oxygen levels lower than normal

77
Q

prophylaxis is recommended for the patients identified in the previous section for all dental procedures that involve what?

A

manipulation of gingival tissue or the periapical region of the teeth, or perforation of the oral mucosa

78
Q

dental care for cardiac patients pre-surgery and pre-transplant

A
  1. review med hx
  2. consult with cardiologist
  3. review dental hx
79
Q

goal of dental care for cardiac patients

A

eliminate all existing or potential sources of infection and trauma in the oral cavity

80
Q

what can be done if it’s not possible to complete all dental tx for cardiac pts?

A

temporary restorations can be placed and non-acute dental tx can be delayed until pt is stable

81
Q

T/F: complete a detailed clinical and radiographic exam as early as possible and determine an aggressive prevention and dental plan

A

true

82
Q

what should be considered when completing a dental tx?

A
  1. pt’s behavior
  2. ability to tolerate tx
  3. amt of dental needs
  4. interest in dental health
  5. urgency of tx completion
  6. need for IE prophylaxis
  7. risk/benefit of maintaining each tooth
  8. risk of infection or bleeding post-op
83
Q

other dental considerations for pediatric heart transplant pts

A
  1. respiratory depressant such as opioids, barbiturates and other sedatives can worsen the cardiovascular status
  2. atropine and similar agents produce tachycardia
  3. N2O-O2 can be used safely
  4. small amt of epi used in LA is not likely to cause serious cardiovascular compromise
84
Q

when would a small amt of epi used in LA will likely cause serious cardiovascular compromise?

A

restricted outflow track defects

  1. aortic stenosis
  2. hypertrophic cardiomyopathy
85
Q

high cariogenic potential of pediatric meds (digoxin, abx, antifungal rinses, etc.) and dietary supplements (i.e. Pediasure) are due to what?

A

lack of growth

86
Q

long-term sequelae of cyclosporine

A
  1. gingival overgrowth (roughly 30-50% pts)

2. cancers (rates ~50%) - skin and oral cancers

87
Q

medication to tx high BP due to cyclosporine use post-surgery/transplant

A

Nifedipine

88
Q

what may Nifedipine cause?

A

gingival hyperplasia

89
Q

anticoagulant therapy to use post-surgery/transplant

A

coumadin and aspirin

90
Q

what should be avoided post-surgery/transplant?

A

avoid NSAIDS, use acetaminophen

91
Q

why should NSAIDS be avoided post-surgery/transplant?

A
  1. increase risk of bleeding

2. can exacerbate heart failure

92
Q

most appropriate INR level of anticoagulation for dental extractions

A

1.5-2.5

93
Q

therapeutic range INR

A

2-4

94
Q

high INR

A

5 or greater

95
Q

what does a high INR indicate?

A

high chance of bleeding

96
Q

low INR

A

~.5

97
Q

what does a low INR indicate?

A

high chance of clotting

98
Q

normal INR

A

0.9-1.3

AU '18 - Peds III exam II (9 decks)

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